BOOSTER SHOTS: Oddities, musings and news from the health world

Placing obese children in foster homes a controversial proposition

Foster care might be the best place for extremely overweight kids — or so says Dr. David Ludwig, director of the Optimal Weight for Life program at Children's Hospital in Boston, and one of the country's leading crusaders against childhood obesity.

It's not going to happen soon. There are no patrols of social workers ready to abscond with the fat kids of America. But Ludwig's suggestion is bound to spark outrage — and perhaps more than a little shame — in parents. They know they have lost control, and they know they could be doing a better job of keeping their kids healthy. But they aren't ready to give up, either.

Writing in the July 13 issue of the Journal of the American Medical Assn., Ludwig says that "parenting deficiencies" can contribute to a child's weight problem. He goes on to say that "in severe cases of childhood obesity, removal from the home may be justifiable from a legal standpoint because of imminent health risks and the parents' chronic failure to address medical problems." He says foster homes would be a last resort, but it's an option that should be kept on the table.

When you see a 150-pound third-grader at the mall, you probably feel sympathy tinged with a little shock. Ludwig evidently sees evidence of child abuse.

He's no crackpot. He clearly feels — with much justification — that kids who have put on huge amounts of weight need a change of environment. But it would be far better if that change could take place in a child's own home, says Edward Garrido, an assistant professor of pediatrics at the University of Colorado School of Medicine who studies the long-term consequences of placing children in foster care. "It's a major disruption to the bond that parents have with children," he says. The emotional scars from such a separation would only add to an overweight kid's problems, he says.

Garrido says it's also too simplistic to say that obesity is a sign of neglect. Some kids, he notes, are biologically geared to put on pounds in bunches. And we're not just talking about "big bones" or "slow metabolism." For one extreme example, kids born with Prader-Willi syndrome feel the need to eat constantly, a drive that can make them dangerously and profoundly overweight.

Childhood obesity is complicated. Fast food, sodas, TV, video games — many staples of modern life are pushing kids in the wrong direction. While researching a book on this topic a few years ago, I spoke with several moms who were tackling their child's weight troubles with varying levels of success. One considered putting locks on her cabinets to keep her son from sneaking food in the middle of the night.

Her son was definitely on the large side — beyond that, really — but it's not because his mom didn't care. And even if someone had placed him in a foster home it wouldn't have solved his problems. As a rule, those places have food in their cupboards, too.